Medicaid-Covered Peer Support Services Used by Enrollees With Opioid Use Disorder

This cross-sectional study provides a multistate description of utilization of Medicaid-covered peer support services in 2019 by enrollees with opioid use disorder (OUD).


Introduction
Peer support workers combine lived experience with formal training to support recovery of people with substance use disorder (SUD). 1 They play an increasingly important role in addressing the opioid crisis. 2 In the US, Medicaid covers approximately 40% of people with opioid use disorder (OUD). 3As of 2018, 37 Medicaid programs covered peer support services (PSS) for SUD. 4 This study provides a multistate description of utilization of Medicaid-covered PSS in 2019.

Methods
This cross-sectional study was approved by the institutional review board at Weill Cornell Medicine.
Informed consent was waived because deidentified patient data were used, in accordance with 45 CFR §46.We followed the STROBE reporting guideline.
We synthesized existing information 4,5 that identified 37 Medicaid programs that covered PSS for SUD in 2018, which were expected to be in implementation by 2019.Additional data collection was conducted on Medicaid coverage and payment rules (including payment codes if applicable) for PSS for SUD (eAppendix 1 in Supplement 1).We excluded 7 states from the original 37 because procedure codes did not exist or could not be identified to measure PSS for the Medicaid program and an additional 2 states because diagnostic or procedure codes for those states were considered unusable by the Medicaid Data Quality Atlas (eAppendix 1 in Supplement 1). 6 used 2019 data from the Transformed Medicaid Statistical Information System Analytical Files.The study population included Medicaid enrollees aged 18 to 64 years who had at least 1 diagnosis of OUD in any health care setting at any time in 2019.The number of days in 2019 for which an enrollee received Medicaid-covered PSS in either an individual or group setting were measured.
We examined variation in the rate of PSS for at least 1 day across Medicaid programs (eAppendix 2 in Supplement 1).We tested differences in enrollee sex, race and ethnicity (collected by states at the time of Medicaid enrollment) (eAppendix 3 in Supplement 1), urban/rural location, and Medicare-Medicaid dual eligibility status by PSS use, with a 2-tailed χ 2 test and clustering at the state level (P < .05 was considered statistically significant).For the 5 Medicaid programs with the largest number of enrollees using PSS, we examined the distribution of number of days receiving PSS.All

Results
The statistical analyses were conducted with Stata MP version 18.0 (StataCorp) between October 2023 and April 2024.
Hawaiian or Pacific Islander, multiracial, missing]; and mean [SD] age, 38.4 [11.1] years).The proportion receiving at least 1 day of PSS ranged from 0.03% in Florida to 26.96% in Arizona, with a median of 3.30% (Figure1).Users and nonusers of Medicaid-covered PSS did not differ significantly Author affiliations and article information are listed at the end of this article.This is an open access article distributed under the terms of the CC-BY License.Medicaid programs (Kentucky, Arizona, Michigan, Ohio, and Oregon) with the largest number of enrollees who used PSS in 2019, the mean (SD) number of days receiving PSS was Downloaded from jamanetwork.combyguest on 07/14/2024 10.4 (17.8) days (median [IQR], 4.0 [1.0-12.0]days;mode=1.0); 39.0% of users received PSS on 1 or 2 days throughout the year, ranging from 24.2% in Kentucky to 52.0% in Arizona (Figure2).In 2019, overall use of Medicaid-covered PSS was infrequent among enrollees with OUD but varied substantially among the 28 states included in the study.Underutilization disproportionately affected dually eligible enrollees who, given the likely greater severity of their disability, could potentially benefit more from PSS.With only 1 to 2 days of Medicaid-covered PSS over an entire year for the largest proportion of users, PSS may not have been effectively utilized to support recovery.Study limitations include restriction to PSS identifiable with known procedure codes, likely variation in program maturity across states, and lack of considerations of other OUD treatment services.Future studies should seek to understand barriers to accessing and providing PSS to Medicaid enrollees and how Medicaid coverage and payment policies could be further developed to support effective delivery of PSS.